Selection of Criteria in the Diagnosis Approach of Paraneoplastic Fever in Adults With Solid Neoplasia Using a Delphi Method

Purpose Paraneoplastic fever (PF) is an exclusion diagnosis that affects around 10% of patients in oncology, combining fever of unknown origin and the presence of cancer. There is no consensus or guidelines in the literature about the minimum criteria required for the diagnosis of (PF). The objective of this survey was to select clinical and paraclinical criteria to establish the diagnosis of PF.Methods After a review of the literature, 23 categories and 48 items were set up in an online survey. A two-round Delphi questionnaire survey was carried out from May to August 2021 with the participation of experts in several specialties in France and abroad.Results Thirty-seven and 33 experts responded in the first and second rounds respectively. Nine items obtained consensus. Among them, the need to rule out suspected infection by a directed bacteriological statement, an up-to-date imaging and doppler ultrasound of the lower limbs was highly consensual. No biological criteria were retained. Thirty-six propositions did not reach consensus and five were considered useless in this setting.Conclusion The 9 selected criteria confirm the importance to eliminating differential fever aetiologies whereas no specific clinical or biological markers were retained. This survey constitute the first consensus of experts in this field.KEYWORDS After this consultation of experts, paraneoplastic fever could be defined as a fever with no aetiology found on an exhaustive clinical, biological and CT work-up, without deep vein thrombosis and no improvement with antibiotic therapy in a cancer patient with tumour necrosis.